Tag: children

Uncategorized

Pressure Mounts to Curtail Surgery on Intersex Children

July 26, 2017

Be the first to like.
Share

NEW YORK — Children whose sexual characteristics don’t neatly align with the norm have for decades faced surgery to rearrange their anatomy to resemble that of more typical boys and girls — long before they were old enough to have a say in the decision.

But now the practice is under assault, as never before. The American Medical Association is considering a proposal discouraging it.

Three former U.S. surgeons general say it’s unjustified. And on Tuesday, Human Rights Watch and InterACT a group advocating for intersex youth — are releasing a detailed report assailing the practice and urging Congress to ban it.

… Read More

Be the first to like.
Share

STAT

Tags: , , , , , , , , , , , ,

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Uncategorized

Germ line genome editing. Current tendency is to accept it, with the ethical difficulties that it entails

In December 2015, an international summit took place in Washington D.C., convened by the United States National Academy of Sciences and the National Academy of Medicine, at which scientists, doctors, bioethicists and specialists in legal matters met to reach a consensus on the application of genome editing (see HERE) in humans, at both laboratory and clinical level.

As a result of this summit, a report was drawn up (see HERE) and has recently been published. The report tackles questions on the application of gene editing in humans, including the balance between the potential benefits and unintended harms, how to govern the use of genome editing, the incorporation of societal values into clinical applications and policy decisions, and respect for the differences across nations and cultures that will determine whether these new technologies will be used and how. One of the most relevant aspects of this report, however, is that it favors the use of genome editing techniques on the germ line, i.e. gametes and early embryos, although restricting their use only to the prevention of serious diseases and providing that there is no other alternative.

The risks of germ line genome editing are unpredictable, aggravated by the fact that the changes produced will be transmitted to offspring. An added concern is that their application to disease prevention could open the door to human enhancement or the production of designer children (see HERE), which would mean modifying our genome to make us stronger, taller, thinner, more intelligent, etc., which is known as transhumanism.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Uncategorized

Tennessee Inmates Consenting to Vasectomies or Birth Control Implants Offered Reduced Time

If Tennessee inmates consent to receiving a free vasectomy or birth control implant, Judge Sam Benningfield has ruled that they can have their jail time reduced by up to thirty days. Critics are claiming that the initiative violates inmates’ constitutional rights, amongst them the American Civil Liberties Union and numerous district attorneys. Advocates are claiming that the program, in effect since May 15th, precludes the potential burden of childrearing for otherwise unintentional parents.

In response to the backlash, Benningfield has emphasized that the procedures are reversible and do not involve sterilization. According to Reuters, he said that “the idea grew out of an earlier program he created with the state’s Department of Health under which inmates’ sentences were reduced by two days if they completed an education program on the risks of raising children while using illegal drugs… Unplanned and unwanted children and the resulting obligations complicate their lives and make their reintegration into society more difficult.”

Nashville’s News Channel 5, which drew attention to the program earlier this week, has stated that 32 women have received the four-year birth control implant and 38 men have signed up for vasectomies. Initially designed for women at risk of birthing children with drug dependencies, the program now encompasses procedures for both sexes in order to avoid discriminatory practices.

“We do not support any policy that could compel incarcerated individuals to seek any particular health services,” said a spokeswoman for Tennessee’s Department of Health. Despite assurances from Benningfield about the procedures’ reversibility, District Attorney Bryant Dunaway said that “it’s comprehensible that an 18-year-old gets this done, it can’t get reversed and then that impacts the rest of their life.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Uncategorized

Hard Lessons: Learning From The Charlie Gard Case

July 25, 2017

Be the first to like.
Share

by Dominic Wilkinson and Julian Savulescu

On the 24th July 2017, the long-running, deeply tragic and emotionally fraught case of Charlie Gard reached its sad conclusion (Box 1). Following further medical assessment of the infant, Charlie’s parents and doctors finally reached agreement that continuing medical treatment was not in Charlie’s best interests. It is expected that life support will be withdrawn in the days ahead.

Over the course of multiple hearings at different levels of the court in both London and Strasbourg, the Charlie Gard case has raised a number of vexed ethical questions (Box 2). The important role of practical ethics in cases like this is to help clarify the key concepts, identify central ethical questions, separate them from questions of scientific fact and subject arguments to critical scrutiny. We have disagreed about the right course of action for Charlie Gard,1 2 but we agree on the key ethical principles as well as the role of ethical analysis and the importance of robust and informed debate. Ethics is not about personal opinion – but about argument, reasons, and rational reflection. While the lasting ramifications of the case for medical treatment decisions in children are yet to become apparent, we here outline some of the potential lessons.

… Read More

Be the first to like.
Share

Practical Ethics

Tags: , , , , , , , , , , , , , ,

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Uncategorized

How Kids See the World Depends a Lot on Genetics

Caption: Child watches video while researchers track his eye movements.
Credit: Washington University School of Medicine, St. Louis

From the time we are born, most of us humans closely watch the world around us, paying special attention to people’s faces and expressions. Now, for the first time, an NIH-funded team has shown that the ways in which children look at faces and many other things are strongly influenced by the genes they’ve inherited from their parents.

The findings come from experiments that tracked the eye movements of toddlers watching videos of other kids or adult caregivers. The experiments showed that identical twins—who share the same genes and the same home environment—spend almost precisely the same proportion of time looking at faces, even when watching different videos. And when identical twins watched the same video, they tended to look at the same thing at almost exactly the same time! In contrast, fraternal twins—who shared the same home environment, but, on average, shared just half of their genes—had patterns of eye movement that were far less similar.

Interestingly, the researchers also found that the visual behaviors most affected in children with autism spectrum disorder (ASD)—attention to another person’s eyes and mouth—were those that also appeared to be the most heavily influenced by genetics. The discovery makes an important connection between two well-known features of ASD: a strong hereditary component and poor eye contact with other people.

The new study was led by Warren Jones, Emory University School of Medicine, Atlanta, and John Constantino, Washington University School of Medicine, St.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Uncategorized

Eugenics in Tennessee

A recent news story from my home state of Tennessee brings up questions of informed consent, reproductive ethics, eugenics, opioid abuse, and other bioethical issues.  In May, White County judge Sam Benningfield issued an order that allows inmates to have their sentences reduced by thirty days if they consent to sterilization procedures: vasectomies for men and (reversible) Nexplanon implants for women.  Benningfield’s order is his response to the repeat drug offenders he sees in the courtroom.  He describes the sterilizations as a means to “encourage personal responsibility,” and also states that, “…if you reach two or three people, maybe that’s two or three kids not being born under the influence of drugs. I see it as a win, win.”

This order is less surprising, perhaps, when considered in light of the United States’ very recent history of eugenics and forced sterilizations. As Kyle Sammin writes at The Federalist,

“[Benningfield’s] idea of ‘trying to break a vicious cycle of repeat offenders’ is, nearly word-for-word, an echo of the Supreme Court’s reasoning in Buck v. Bell, the 1927 case that upheld Virginia’s policy of sterilizing state asylum inmates without their consent. The decision by Justice Oliver Wendell Holmes laid out a similar desire to break a cycle of reproduction by people the judge viewed as unworthy of life: ‘It is better…if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind….Three generations of imbeciles are enough.’”

Benningfield’s order deems inmates’ potential future children as unworthy of life because of their parents’ situations.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Uncategorized

Hard lessons: learning from the Charlie Gard case

by Dominic Wilkinson and Julian Savulescu

 

On the 24th July 2017, the long-running, deeply tragic and emotionally fraught case of Charlie Gard reached its sad conclusion (Box 1). Following further medical assessment of the infant, Charlie’s parents and doctors finally reached agreement that continuing medical treatment was not in Charlie’s best interests. It is expected that life support will be withdrawn in the days ahead.

Over the course of multiple hearings at different levels of the court in both London and Strasbourg, the Charlie Gard case has raised a number of vexed ethical questions (Box 2). The important role of practical ethics in cases like this is to help clarify the key concepts, identify central ethical questions, separate them from questions of scientific fact and subject arguments to critical scrutiny. We have disagreed about the right course of action for Charlie Gard,1 2 but we agree on the key ethical principles as well as the role of ethical analysis and the importance of robust and informed debate. Ethics is not about personal opinion – but about argument, reasons, and rational reflection. While the lasting ramifications of the case for medical treatment decisions in children are yet to become apparent, we here outline some of the potential lessons.

1. Parents’ role in decision-making for children: We need to clarify harm

Much of the media attention to the Gard case has focussed on the rights of parents in decision-making for children, and whether the intervention of the courts in this case means that doctors frequently overrule parents in the UK.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Uncategorized

Charlie Gard, Baby Doe and the Wisdom of Bill Bartholome

The family of Charlie Gard

The Charlie Gard case in the UK has captured international attention regarding the best interest of an 11-month old child with terminal illness whose parents and medical providers in London can’t agree on the best course of treatment and care.

The apparently irreconcilable disagreements between the parents and his care providers have extended from weeks into months and, according to the English news source The Telegraph on Wednesday, July 19, the impasse may likely continue. Reportedly, Mr. Justice Francis, the High Court judge managing the case, confirmed that they are “due to hold further hearings later this month,” following the much-awaited American neurologist’s examination of Charlie that took place earlier this week.

Should Charlie’s parents be granted permission, allowing him to receive the experimental treatment they seek on his behalf, or is what they seek not in Charlie’s best interest due to the severity of his illness and the uncertainty surrounding the benefit of the experimental treatment?
These difficult and highly emotional cases are not without precedent. An historical perspective may be helpful in exploring the ethical dimensions of how best to proceed in situations like these.

What follows is a reflection by Myra Christopher on the Center for Practical Bioethics’ work in developing Healthcare Treatment Decision Making for Minors, including infants, that is now more than two decades old.

– – – – – – – – – – –

“Don’t forget about children” was Bill Bartholome’s response when I asked, shortly before his death in 1999, how we could honor him.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Uncategorized

‘A bit of a compromise’: Coming to terms with an emergency caesarean section by Terena Koster

During the midwife-hosted antenatal class Cath attended in a private hospital in Cape Town, South Africa, where she would eventually give birth, pregnant women were encouraged to name the kind of birth they wanted. They were presented with three options: “natural all the way with no medication”, “natural but open to medication”, or “elective caesarean”. The ‘choice’ women were expected to make featured as an important point of concern in their antenatal care and in their preparations for birth.

Hannah, a participant in the class, recalls a particularly striking moment when the midwife went around the room and pointed at each of the participants and asked, “Who is your gynae”. She went on to predict diverse birth outcomes, irrespective of participants’ stated intentions to birth vaginally. For Hannah this was an “eye opening” experience. A first time mother, she was now invited into a highly politicised birthing environment. Hannah had been uncertain about what kind of birth she wanted, but at 8 months pregnant she had decided on a ‘natural’ birth as opposed to a ‘caesarean’, with the caveat that in the event that an emergency caesarean section was a likely outcome, she would proactively opt for an elective caesarean.

At 39 weeks and near the end of her pregnancy, she found herself sitting opposite her obstetrician who told her there was “a real threat of the umbilical cord wrapping around [the baby’s] neck as she … drop[s] down,” adding that because the baby was “so big” there was “a high likelihood of [Hannah] tearing”. For the first time, the obstetrician instructed her to make a birthing decision: to continue trying for a vaginal birth or to opt for an elective caesarean section.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Uncategorized

When a doctor calls a patient a racial slur, who is hurt?

by Keisha Ray, Ph.D.

Last week Lexi Carter, a black woman from Tennessee had an experience that so many other black people have had, a racially charged visit with a doctor. When Carter walked into her doctor’s office, Dr. James Turner greeted her with “Hi Aunt Jemima.” During the visit, he proceeded to call her Aunt Jemima more than once. Carter’s encounter with Dr. Turner is problematic for many reasons: 1. The term “Aunt Jemima,” which is the name of a popular syrup and pancake mix whose packaging depicts the face of a black woman, has a long history of racism dating back to the late 1800s; 2. Dr. Turner made these remarks in front a physician assistant trainee and a student who are still learning about the field of medicine; 3. After admitting to making the remark, Dr. Turner said that the term “was not intended to show disrespect for Ms. Carter,” calling it a “misspoken blunder.”

Aunt Jemima is a reflection of the “mammy” archetype that can be found in films, television shows, and literature (e.g. Calpurnia in “To Kill a Mocking bird” or Mammie in “Gone with the Wind”). The archetype depicts a larger black woman who is usually wearing an apron over a tattered dress, her hair is usually tied up with a scarf of some sort (typical of black slaves who tied their hair up to help protect from lice). The mammie character is also typically responsible for caring for the homes and children of white slave owners (i.e. house slaves), and who speaks using vernacular typical of uneducated black slaves, a vernacular that is usually mocked for being simple and unrefined unlike that of the vernacular of white people.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.